Peripheral arterial disease narrows the arteries of the legs and feet. Early signs include calf or thigh cramping when walking, which eases with rest. Later, pain at rest, cold or pale feet, and wounds that will not heal point to a threatened limb. Smoking, diabetes, high blood pressure and high cholesterol are the main causes.

Care begins with walking exercise, medicines and treating risk factors. When blood flow is still inadequate, the team considers angioplasty and stenting or bypass surgery. The aim is to relieve pain, heal wounds and avoid amputation. Risks include bleeding, infection, re-narrowing and heart complications, and the team discusses all of them before any procedure.

Care in this subspecialty includes:

• Pulse, Pressure and Doppler Assessment: Measurement of leg pulses and blood pressure at the ankle, along with Doppler ultrasound, to show where the arteries are narrowed and how severe the problem is.
• Medicines and Supervised Exercise: Antiplatelet and cholesterol medicines with a structured walking programme, which often increases walking distance without a procedure.
• Angioplasty and Stenting: Balloon widening of suitable blockages, with a stent where needed, through a small puncture in the groin or ankle.
• Bypass Surgery: A graft that carries blood around longer or more complex blockages, used when catheter treatment is unlikely to last or is not possible.